Orgasmic disorders: anhedonia
Problems with orgasms, while not as common as other sexual disorders, are among the most frustrating sexual health problems. To be clear, we’re talking about orgasms, not ejaculations. An orgasm is the euphoric feeling that occurs primarily in the brain and is a sudden release of a cocktail of hormones and chemicals. Because orgasms are a combination of neurological phenomenon, brain chemistry, emotional state, and arousal, the problems are very complicated to diagnose and treat.
The two most common problems we see are ejaculatory anhedonia and sexual anhedonia. Anhedonia is based on the Greek root for pleasure; This is the source of the word “hedonism”. Anhedonia means lack of pleasure. With sexual anhedonia, sexual stimulation and arousal just don’t feel comfortable. In ejaculatory anhedonia, there is no euphoric orgasm associated with ejaculation.
These disorders are very frustrating for the patient and often lead to considerable psychological and emotional stress. The typical scenario is that a man is functioning perfectly normally and, due to certain circumstances or events, loses his sense of sexual pleasure. It can be a sudden onset or a gradual decline.
Diagnosis is complicated because we have to rely solely on individual reports and responses. There is no test to determine orgasm function or the pleasure obtained from stimulation. Many men went to different doctors for help. Virtually every patient has been told that there is nothing wrong with them and that everything is on their mind. However, this is a very real problem and it can destroy a man’s sex life.
Part of our diagnostic process is to do a full medical and physical exam. There are several hormonal issues that can contribute to this problem. Low testosterone levels can be involved. Too much prolactin can be a culprit. Medication can cause problems. SSRIs (antidepressants) are known to cause sexual anhedonia. Blood pressure medication can also help. Neuropathy can be involved and some diabetics report sensory problems.
The psychiatrist will also look at various factors. Depression or anxiety can cause anhedonia. Relationship problems can complicate things. Trauma of any kind can be a culprit. And as with most sexual things, once the train wreck is involved in the brain, things go downhill very quickly. In order to diagnose this problem, probable causes must be ruled out. This takes time and perseverance.
Treatment largely depends on the cause – if it can be determined. There are drugs that can increase the level of dopamine in the brain, which is a major part of an orgasm. Creating optimal testosterone levels is often part of the treatment. Medical treatment for depression and anxiety requires the use of drugs that tend to have fewer sexual side effects. Sex therapy is often a good idea. Psychotherapy is usually recommended because it is a complicated problem and can be very frustrating.
Alternative therapies can include both acupuncture and hypnotherapy. Some men have found relief by changing their diet and finding that their bodies react badly to something they have eaten. Some men try chiropractic treatments. Alcohol tends to make anhedonia worse. I got patients to use Reiki healing. Basically, there is no treatment that is off the table when it comes to treating this elusive condition. We will support the patient in his search and leave no stone unturned.
Because this is a less common condition, feelings of isolation and loneliness are very common among these men. Often times the men tell me that they feel “broken” and like “damaged goods”. This is where sex education and therapy can help patients manage this disease while we investigate treatments. While this is unusual, this condition is more common than people think.
If you suffer from any type of anhedonia, begin your healing journey with qualified professionals. Contact us for a free telephone consultation.